Scapular tumor resection and reconstruction

Indication Scapular tumor resection and reconstruction are suitable for some low-malignant tumors of the scapula. Such as giant cell tumor of bone, low-grade malignant chondrosarcoma, osteofibrosarcoma, paracortical osteosarcoma and so on. Preoperative preparation 1. Review the medical history, do a good job in blood and urine routine examination and heart, lung, liver and kidney function tests, and strive to obtain biopsy pathological tissue confirmation and review X-ray photos. 2. Fully preoperative discussion, if necessary, invite radiation, pathology, anesthesia related physicians to participate. Determine the diagnosis, surgical plan, etc. 3. According to the scope of surgery (partial, sub-total, total resection) with adequate blood and blood transfusion. 4. Malignant bone tumors, especially the resection of high-malignant bone tumors, should be performed 1 to 3 chemotherapy courses before surgery, and then scapular bone resection. Surgical procedure 1.Ryerson's Operation (1) The skin incision starts from the shoulder peak, and the scapula is inward to the scapula spine, and then turns to the inferior corner of the scapula. (2) Cut the subcutaneous and deep fascia, pull the flap inward and outward, and show the muscles attached to the back of the scapula. Cut off the acromioclavicular ligament from the upper corner, and then remove the deltoid from the shoulder. Cut at the middle and third stop points, and then cut the upper and lower trapezius muscles, the scapula levator muscles and the rhomboid muscle attached to the lower corner. (3) From the free deltoid muscle of the acromion to the outer end of the clavicle, the diaphragm that stops on the condyle can be seen after the muscle is removed, and the biceps long head and the chest muscle are cut off. . (4) A horseshoe-shaped arc-shaped incision is made from the front to the back to reveal the inner edge of the large tibial tuberosity. The scapula tendon is stopped and the biceps long head is cut. Then cut the supraspinatus, the infraspinatus muscle, and the small round muscle from the scapula to cut off the ligament and most of the joint capsule. Finally, cut off all the soft tissues attached to the scapula. The entire scapula and tumor were Free cut. (5) If the artificial scapula replacement is not planned, the humerus and the outer end of the clavicle can be suspended and fixed. Since the upper limb has been in a semi-disengaged state of the shoulder, the second assistant of the operation should pay special attention to the entire upper limb. The surgeon can drill a 3.5mm hole in the outer end of the clavicle and the large tibia, and twist it with a 1mm thick stainless steel wire (double strand) to stabilize the clavicle and the humeral head. Next, the deltoid muscle and the trapezius muscle are relatively sutured, and the muscles of the scapula such as the biceps and triceps are sutured with the muscles in the opposite direction. (6) The wound is drained and layered and sutured. 2.Das Gupta's Operation (1) The patient is lying prone, the upper arm is abducted by 90°, and the upper limb is wrapped with a sterile towel to facilitate the intraoperative operation. The incision is cut from the shoulder to the lower corner of the scapula. If the tumor is larger, the fusiform incision can be made to cut the middle cortex, and the skin on both sides is turned inward and outward. (2) Cut the trapezius muscle from the shoulder scapula and pull it upwards to reveal the supraspinatus muscle, cut off the deltoid muscle on the shoulder and the scapula, and cut the latissimus dorsi from the lower corner of the scapula and pull it down. open. At this point, the assistant can use the towel clamp to clamp the lower corner of the shoulder blade, pull down to the outside to tighten all the muscles of the scapula spine, and then cut off from the shoulder. (3) The upper arm is retracted to relax the axillary tissue, and the outer edge of the scapula is attached to the outer diameter of the scapula and the deltoid long head, Gangshang, and Gang under the shoulder blade. Next, cut off the stop points of the front saw muscles. In this way, the shoulder joint is fully exposed, and the scapula can be sawed by a callus or a wire saw (sub-total resection). (4) If the scapula is completely removed, it can be separated from the shoulder to the scapula and the condyle, and the long head of the biceps, the small muscles of the chest, the diaphragm and the muscles of the scapula and the inner side of the scapula are cut off. At the end, the scapula and its tumor are all cut. After hemostasis ligation, the trapezius muscle is sutured to the deltoid muscle, and the large and small muscles are sewn on the chest wall. (5) The wound is layered and sutured after the flow strip is released. 3. Prosthetic replacement after scapula resection The designed scapula prosthesis should be sterilized before surgery. The prosthesis is generally attached to the main muscle ligament, and the holes are drilled in advance and the holes are drilled in a sieve to facilitate the adhesion of the muscle. After the scapula and tumor have been removed by the aforementioned Ryerson or Das Gupta procedure, the scapula prosthesis can be implanted. When suturing, the assistant can first use the steel wire to pull the prosthesis to fix the position. First, the diaphragm, the biceps short head and the pectoralis minor muscle are sewn on the in situ condyle, and the biceps long head is quilted in the ridge. On the upper tendon or aponeurosis, repair the severed sacral ligament, tie the shoulder and the outer end of the clavicle with steel wire, and sew the subscapularis and the round and small muscles back into place. The rib surface of the prosthesis is placed in a negative pressure drainage tube and connected to the aspirator, and the wound is layered and sealed. 4.Phelps Partial Resection of Scapula (1) Incision: the scapula from the external inward incision to the inner edge, then turn down to the lower scapula, flap and deep fascia. (2) Cut the trapezius muscle from the scapula and pull it inward and upward. Then cut the rhombic muscle, the infraspinatus muscle, the subscapularis muscle, the latissimus dorsi, the anterior serratus, and the round and small muscles on the scapula. (3) After the free scapula is satisfied, the scapula can be lifted to check the condition of any tumor in the deep front. If found, the rongeur can be used to remove all bones of the scapula and below. (4) When the wound is finally closed, the subscapularis muscle can be sutured to the lateral edge of the large and small round muscles, the anterior serratus muscle is sutured with the medial edge thereof, and the infraspinatus muscle and the small round muscle are sutured together. Finally, the combination of the several muscles is combined. The muscles are sutured to the upper and lower scapula of the scapula with the trapezius and rhomboid muscles. (5) After the drainage, the wound is layered and sutured. The other treatments are basically the same as the first two procedures.